Nevin Manimala

JMIR Aging. 2021 Nov 24;4(4):e16006. doi: 10.2196/16006.

ABSTRACT

BACKGROUND: The rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients’ ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.

OBJECTIVE: We explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.

METHODS: Our study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.

RESULTS: Age (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).

CONCLUSIONS: This study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.

PMID:34822340 | DOI:10.2196/16006

Ceylon Med J. 2020 Dec 31;65(4):79-85. doi: 10.4038/cmj.v65i4.9276.

ABSTRACT

INTRODUCTION: The majority of Sri Lankan Moors fast during Ramadan. This may have an effect on their glycaemic control and anthropometric parameters. However, limited information exists about the impact of Ramadan fasting on diabetes in Sri Lanka.

OBJECTIVES: The main objective of this study was to investigate the effect of Ramadan fasting on glycaemic control and anthropometric parameters in patients with type 2 diabetes mellitus (T2DM). Patients were also observed for symptoms of hypoglycaemia, timing and association with different antidiabetic agents.

METHODS: One hundred and twenty Sri Lankan Moors with T2DM were recruited for this study. Biochemical investigations and anthropometric parameters were done before and after Ramadan fasting. The statistical analysis was done with paired t test to compare glycaemic control and anthropometric parameters before and after Ramadan.

RESULTS: There was a significant decrease in body weight (mean body weight 66.17 to 65.52 kg; p= < 0.001) and waist circumference (93.84 to 92.16cm; p= < 0.001). However, the glycaemic control worsened in all patients during Ramadan with rise in mean fructosamine value of 354.1 to 996.9µmol/L. Out of 104 participants 43 participants experienced symptoms of hypoglycaemia.

CONCLUSIONS: The current study showed an improvement in the body weight and waist circumference during Ramadan fasting, however the glycaemic control has been worsened. More follow-up studies are warranted in order to draw a conclusion on the effect of Ramadan fasting in glycaemic control and anthropometric parameters in diabetes patients.

PMID:34821486 | DOI:10.4038/cmj.v65i4.9276

Vet Ophthalmol. 2021 Nov 25. doi: 10.1111/vop.12947. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered ectopic cilium (EC).

ANIMALS STUDIED: One hundred and twelve dogs from multiple private practices in France, with a clinical diagnosis of EC were included in the study.

RESULTS: The mean age of affected dogs was 2.3 years. There were 64 females and 48 males. The most represented breeds were the Shi Tzu, the French Bulldog, the English Bulldog and the Chihuahua. Eleven dogs were affected bilaterally. The upper eyelid was implicated in 93.5% of the cases, with the median portion being the most affected. No statistical difference was observed between the right and the left eye. EC were associated with distichiasis in 50% of the cases. Pigmentation of the conjunctiva at the point of exit of the EC was present in 58% of the cases. EC were short in 75% and long in 25% of the cases. Corneal complications were statistically associated with short EC. The corneal lesions associated with EC were keratitis (94%), corneal granuloma (0.8%), corneal fibrosis (2.7%), corneal degeneration (0.8%), superficial corneal ulcer (68.7%), deep corneal ulcer (8%) and perforating corneal ulcer (0.8%). The surgeries which consisted of the removal of the hair follicle was successful in 88.4% of the cases.

CONCLUSION: EC is a rare condition which can be treated successfully by the removal of the hair follicles. It must be suspected in cases of corneal lesions unresponsive to medical treatment.

PMID:34821455 | DOI:10.1111/vop.12947

Biom J. 2021 Nov 25. doi: 10.1002/bimj.202000015. Online ahead of print.

ABSTRACT

In many biomedical studies or clinical trials, we have data with more than one response variable on the same subject repeatedly measured over time. In analyzing such data, we adopt a multivariate linear mixed-effects longitudinal model. On the other hand, in longitudinal data, we often find features that do not impact modeling the response variable and are eliminated from the study. In this paper, we consider the problem of simultaneous variable selection and estimation in a multivariate t linear mixed-effects model (MtLMM) for analyzing longitudinally measured multioutcome data. This work’s motivation comes from a cohort study of patients with primary biliary cirrhosis. The interest is eliminating insignificant variables using the smoothly clipped and absolute deviation penalty function in the MtLMM. The proposed penalized model offers robustness and flexibility to accommodate fat tails. An expectation conditional maximization algorithm is employed for the computation of maximum likelihood estimates of parameters. The calculation of standard errors is affected by an information-based method. The methodology is illustrated by analyzing Mayo Clinic Primary Biliary Cirrhosis sequential (PBCseq) data and a simulation study. We found drugs and sex can be eliminated from the PBCseq analysis, and over time the disease progresses.

PMID:34821410 | DOI:10.1002/bimj.202000015

Stat Med. 2021 Nov 25. doi: 10.1002/sim.9265. Online ahead of print.

ABSTRACT

A Bayesian biomarker-based phase I/II design (BIPSE) is presented for immunotherapy trials with a progression-free survival (PFS) endpoint. The objective is to identify the subgroup-specific optimal dose, defined as the dose with the best risk-benefit tradeoff in each biomarker subgroup. We jointly model the immune response, toxicity outcome, and PFS with information borrowing across subgroups. A plateau model is used to describe the marginal distribution of the immune response. Conditional on the immune response, we model toxicity using probit regression and model PFS using the mixture cure rate model. During the trial, based on the accumulating data, we continuously update model estimates and adaptively randomize patients to doses with high desirability within each subgroup. Simulation studies show that the BIPSE design has desirable operating characteristics in selecting the subgroup-specific optimal doses and allocating patients to those optimal doses, and outperforms conventional designs.

PMID:34821409 | DOI:10.1002/sim.9265

Med Phys. 2021 Nov 25. doi: 10.1002/mp.15380. Online ahead of print.

ABSTRACT

PURPOSE: The common practice in acquiring the magnetic resonance (MR) images is to obtain two-dimensional (2D) slices at coarse locations while keeping the high in-plane resolution in order to ensure enough body coverage while shortening the MR scan time. The aim of this study is to propose a novel method to generate HR MR images from low resolution MR images along the longitudinal direction. In order to address the difficulty of collecting paired low- and high-resolution MR images in clinical settings and to gain the advantage of parallel cycle consistent generative adversarial networks (CycleGANs) in synthesizing realistic medical images, we developed a parallel CycleGANs based method using a self-supervised strategy.

METHODS AND MATERIALS: The proposed workflow consists of two parallelly trained CycleGANs to independently predict the HR MR images in the two planes along the directions that is orthogonal to the longitudinal MR scan direction. Then the final synthetic HR MR images are generated by fusing the two predicted images. MR images, including T1-weighted (T1), contrast enhanced T1-weighted (T1CE), T2-weighted (T2) and T2 Fluid Attenuated Inversion Recovery (FLAIR), of the multimodal brain tumor segmentation challenge 2020 (BraTS2020) dataset were processed to evaluate the proposed workflow along the cranial-caudal (CC), lateral and anterior-posterior directions. Institutional collected MR images were also processed for evaluation of the proposed method. The performance of the proposed method was investigated via both qualitative and quantitative evaluations. Metrics of normalized mean absolute error (NMAE), peak signal-to-noise ratio (PSNR), edge keeping index (EKI), structural similarity index measurement (SSIM), information fidelity criterion (IFC) and visual information fidelity in pixel domain (VIFP) were calculated.

RESULTS: It is shown that the proposed method can generate HR MR images visually indistinguishable from the ground truth in the investigations on the BraTS2020 dataset. In addition, the intensity profiles, difference images and SSIM maps can also confirm the feasibility of the proposed method for synthesizing HR MR images. Quantitative evaluations on the BraTS2020 dataset shows that the calculated metrics of synthetic HR MR images can all be enhanced for the T1, T1CE, T2 and FLAIR images. The enhancements in the numerical metrics over the low-resolution and bi-cubic interpolated MR images are statistically significant. Qualitative evaluation of the synthetic HR MR images of the clinical collected dataset could also confirm the feasibility of the proposed method.

CONCLUSIONS: The proposed method is feasible to synthesize HR MR images using self-supervised parallel CycleGANs, which can be expected to shorten MR acquisition time in clinical practices. This article is protected by copyright. All rights reserved.

PMID:34821395 | DOI:10.1002/mp.15380

J Med Virol. 2021 Nov 25. doi: 10.1002/jmv.27475. Online ahead of print.

ABSTRACT

BACKGROUND: Interferons are essential part of the innate immune system and have antiviral and immunomodulatory functions. We studied the effects of Interferon β-1a on outcomes of severe cases of COVID-19.

MATERIAL AND METHODS: This retrospective study was conducted on hospitalized COVID-19 patients in Loghman-Hakim hospital from 20 February 2020 to 20 April 2020, Tehran, Iran. Patients were selected from two groups, the first group received Interferon β-1a in addition to standard treatment regimen, and the second group received standard care. The clinical progression of two groups during their hospital admission has been compared.

RESULTS: We studied a total number of 395 hospitalized COVID-19 patients. Out of this number, 111 patients (33.5%) died (31.3% of the Interferon β-1a group and 34.1% of the control group). Mortality rate indicated no statistically significant difference between groups (p-value = 0.348), however for patients who were hospitalized for more than a week, the rate of mortality was lower in the Interferon β-1a group (p-value = 0.014). The median hospital stay was statistically longer for patients treated by Interferon β-1a (p-value <0.001).

CONCLUSION: The results of this study showed that Interferon β-1a can improve the outcomes of hospitalized patients with severe COVID-19, but more adequately-powered randomized controlled trials should be conducted. This article is protected by copyright. All rights reserved.

PMID:34821387 | DOI:10.1002/jmv.27475

J Med Virol. 2021 Nov 25. doi: 10.1002/jmv.27477. Online ahead of print.

ABSTRACT

As the present coronavirus disease 2019 (COVID-19) spreads and existing data suggested susceptibility factors for developing a severe course of the disease. This case-control experiment aimed to study the associations of genetic polymorphisms in tumor necrosis factors (TNFs) with COVID-19 and its mortality rate. A total of 550 participants (275 subjects and 275 controls) were enrolled. The tetra-ARMS-PCR technique was recruited to detect -308G>A TNFα and +252A>G TNFβ polymorphisms among the Iranian population. We demonstrated that participants carrying the G allele of TNFβ-252A/G, rs909253 A>G was more frequent in COVID-19 subjects compared to the healthy group and statistically increased the disease risk (OR=1.55, 95% CI=1.23-1.96, P<0.0001). At the same time, the A allele of TNFα-311A/G, rs1800629 G>A moderately decreased the risk of COVID-19 (OR=0.68, 95% CI=0.53-0.86, P<0.002). Also, we analyzed the various genotypes regarding the para-clinical and disorder severity; we found that the AA genotype of TNFβ-252A/G, rs909253 A>G, the CT scan pattern was different in comparison to cases in the AG genotype with P ₁ <0.001. In addition, in the severe cases of COVID-19, leucocyte and neutrophil count and duration of ICU hospitalization in the death group have been significantly increased (P<0.001). Moreover, the TNFα-311A/G, rs1800629 G>A variant is likely to change the pattern of splicing factor sites. Our findings provided deep insights into the relationship between TNFα/TNFβ polymorphisms and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Replicated studies may give scientific evidence for exploring molecular mechanisms of COVID-19 in other ethnicities. This article is protected by copyright. All rights reserved.

PMID:34821383 | DOI:10.1002/jmv.27477

Clin Ter. 2021 Nov 22;172(6):542-546. doi: 10.7417/CT.2021.2375.

ABSTRACT

BACKGROUND: Tibial plateau fractures pose multiple challenges to the surgeon given their frequent intra-articular involvement and the tendency to displace under axial load. The aim of this study is to de-scribe the clinical outcomes of a retrospective case series in which tibial plateau fractures were not treated with PL fragment osteosynthesis.

METHODS: In the present retrospective study, we included patients treated for tibial plateau fracture with PL fragment in our department from January 2016 to January 2020. All patients were seen at the outpa-tient clinic 2 and 5 weeks after surgery, and at 3, 6 and 12 months, and thereafter at regular intervals, depending on the overall clinical status. Every patient included in this study was then contacted by phone to assess self-reported clinical outcomes. The Oxford Knee Score (OKS) questionnaire was used to assess functional outcomes. Patients were divided in six groups depending on the three-column classification by Lou (groups A1-A6). Patients were also divided in four groups based on the whole area of the PL column and on the depression of the PL fragment (group B1-B4). One-way ANOVA was used to compare groups of patients.

RESULTS: OKS scores, extension and step-off of the PL fragment were analyzed in groups A1 – A6. No significant differences between OKS scores and step-off were found, while statistical difference was found between surfaces of PL fragment. No significant difference was found between OKS scores in groups B1-B4.

CONCLUSION: Our findings suggest that the treatment outcome is influenced not only by the superficial involvement or collapse of PL fragments, but also by other variables, including BMI, pre-injury physi-cal health, and age.

PMID:34821349 | DOI:10.7417/CT.2021.2375

Rev Esp Salud Publica. 2021 Nov 25;95:e202111195.

ABSTRACT

OBJECTIVE: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD).

METHODS: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison.

RESULTS: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay).

CONCLUSIONS: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD.

PMID:34821224